NHS Corby CCG Governing Body Meeting in Public · A G E N D A NHS Corby CCG Governing Body Meeting...

NHS Corby CCG Governing Body Meeting in Public

Tuesday 26 February 2019

09:30

Meeting Room 1 Corby Enterprise Centre, London Road, Corby NN17 5EU

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A G E N D A

NHS Corby CCG Governing Body Meeting in Public Tuesday 26 February 2019 at 09:30

Meeting Room 1, Corby Enterprise Centre, London Road, Corby, NN17 5EU

Time Agenda Item Action Presenter Reference INTRODUCTORY ITEMS 09:30 1. Welcome, Apologies and On Call Director Note Dr Joanne Watt Verbal

2. Declarations of Interest relating to agenda items Members are reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of NHS Corby Clinical Commissioning Group.

Note Dr Joanne Watt Verbal

3. Minutes of Governing Body Meeting in Public held on 18 December 2018

Approve Dr Joanne Watt GB-19-01

4. Matters Arising and Action Log

Note Dr Joanne Watt GB-19-02

09:35 5. Clinical Chair’s Report Note Dr Joanne Watt Verbal

09:40 6. Chief Executive’s Report

Note Toby Sanders GB-19-03

09:45 7. Questions from members of the public: Members of the public will be given the opportunity to ask questions which have been submitted in advance. These must relate to items that are on the agenda and responses will be provided under item 8 of the agenda.


8. Response to questions raised by the Public Note Dr Joanne Watt Verbal

RISK ASSURANCE 09:50 9. Governing Body Assurance Framework Assurance Neil Boughton GB-19-04

STRATEGY AND PLANNING 10:00 10. 2019/20 Operational Plan Assurance and

Approve

Caron Williams GB-19-05

10:15 11. Draft Financial Plan 2019/20 Information Stuart Rees GB-19-06

10:30 12. Procurement Outcome Corby CCG Urgent Care Centre Service

Note Caron Williams GB-19-07

10:35 13. Procurement Outcome Corby CCG Extended Access Service

Note Caron Williams GB-19-08

QUALITY & PERFORMANCE 10:40 14. Quality & Safeguarding Report Assurance Alison Jamson GB-19-09

10:50 15. Performance Report Assurance Kathryn Moody GB-19-10

BREAK FINANCE & GOVERNANCE 11:05 16. Finance, Transformation and Savings Report

Assurance Stuart Rees GB-19-11

11:15 17. Equality Delivery System 2 Approve Judith Glashen GB-19-12

11:30 18. Joint Health & Safety Policy Ratify Neil Boughton GB-19-13

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Time Agenda Item Action Presenter Reference SYSTEM UPDATES 11:35 19. Northamptonshire Health and Care

Partnership Board Update

Note Toby Sanders GB-19-14

11:40 20. Public Health Update

Note Lucy Wightman GB-19-15

11:50 21. Focus Review on Governing Body Assurance Framework

Assurance Neil Boughton Verbal

12:00 22. Key Messages from Corby CCG Governing Body Meeting


FOR INFORMATION HIGHLIGHT REPORTS GB-19-16

23. • Audit and Risk Committee 7 February 2019 • Council of Members 22 January 2019 • Joint Executive Management Team 5 February 2019 • Joint Finance Committee 5 February 2019 • Joint Quality Committee 12 February 2019 • Primary Care Commissioning Committee 15 January 2019

APPROVED MINUTES GB-19-17 24. • Audit and Risk Committee 20 November 2018

• Council of Members 20 November 2018 • Joint Executive Management Team 4 December 2018 and 8 January 2019 • Joint Finance Committee 4 December 2018 and 8 January 2019 • Joint Quality Committee 14 August, 9 October and 11 December 2018 • Primary Care Commissioning Committee 27 November 2018 • Health and Wellbeing Board minutes from 15 November 2018

DATE OF NEXT MEETING NHS Corby CCG and NHS Nene CCG Governing Bodies will be meeting in Common in Public on Tuesday 16 April 2019 at 13:30 in the Board Room at Francis Crick House, Summerhouse Road, Moulton Park, Northampton NN3 6BF. CONFIDENTIAL MOTION To resolve that as publicity on items contained in Part II of the agenda would be prejudicial to public interest by reason of their confidential nature, representatives of the press and members of the public should be excluded from the remainder of the meeting. Section 1 (2) Public Bodies (Admission to Meetings) Act 1960.

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GB-19-01

NHS Corby CCG Minutes of the Governing Body Meeting in Public

Tuesday 18 December 2018 at 09:30 in Meeting Room 1 Corby Enterprise Centre London Road, Priors Hall Corby NN17 5EU

Present Dr Joanne Watt Clinical Chair (Chair) Miss Joanne Brodrick Independent Lay Member Mrs Angela Dempsey Joint Registered Nurse Governing Body Member, NHS Corby CCG and NHS

Nene CCG Professor Devaka Fernando Joint Secondary Care Doctor, NHS Corby CCG and NHS Nene CCG Mr Andrew Hammond Deputy Lay Chair and Lay Member for Governance Mrs Tansi Harper Lay Member, Patient & Public Engagement Mr Stuart Rees Joint Chief Finance Officer, NHS Corby CCG and NHS Nene CCG Mr Toby Sanders Joint Chief Executive, NHS Corby CCG and NHS Nene CCG Dr Nathan Spencer GP Governing Body Member In Attendance Mrs Emma Follis Corporate Services and Governance Manager, NHS Corby CCG and NHS Nene

CCG Ms Bie Grobet Deputy Director of Health, Strategy and Planning, NHS Corby CCG and NHS

Nene CCG Mrs Alison Jamson Deputy Director of Quality, NHS Corby CCG and NHS Nene CCG Dr David N Jones Chair, HealthWatch Mrs Sarah McKenzie Board Secretary, NHS Corby CCG and NHS Nene CCG Mrs Kathryn Moody Director of Contracting and Delivery, NHS Corby CCG and NHS Nene CCG Mrs Lucy Wightman Director of Public Health & Wellbeing, Northamptonshire County Council Mr Matt Youdale Director, ARCH Communications Apologies Mr Neil Boughton Deputy Director for Corporate Affairs, NHS Corby CCG and NHS Nene CCG Dr Sanjay Gadhia GP Governing Body Member Mrs Caron Williams Director of Health, Strategy and Planning, NHS Corby CCG and NHS Nene CCG

Minute No: Agenda Item

GB18/19 130 Welcome, Apologies and On-Call Director

Dr Watt welcomed the Governing Body and members of the public to the meeting.

Apologies for absence were noted as above.

Due notice had been given in line with the Constitution and the meeting was quorate.

Mr Sanders advised that he was the current Director On Call and that he might need to leave the meeting to receive urgent calls requiring his attention.

GB18/19 131 Declarations of Interest There were no declarations of interest for items pertaining to the agenda raised by members of the Governing Body.

GB18/19 132 Minutes of the meeting held on 30 October 2018 The minutes of the Governing Body meeting held on 30 October 2018 were presented and were APPROVED as a true and accurate recording of proceedings.

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GB18/19 133 Matters Arising and Action Log The matters arising and action log from 30 October 2018 meeting were considered by the Governing Body. Further actions were noted and would be added to the log and circulated.

Action: Mrs McKenzie The Governing Body NOTED the Matters Arising and Action Log.

GB18/19 134 Chair’s Report Dr Watt reported that she had attended a variety of meetings in the county which included the Clinical Commissioning Leads Group, Health and Wellbeing Board, Northamptonshire Health and Care Partnership Board (NHCP), Corby Health and Wellbeing Forum, Chairs and Non-Executive Directors (NEDs) meeting and she had met with Alan Burns, Chair of Kettering General Hospital (KGH).

Dr Watt extended a warm welcome to Mrs Dempsey, Joint Registered Nurse and to Toby Sanders, Joint Chief Executive who were attending their first meeting.

Dr Watt’s monthly Corby Radio slot for December covered ‘flu’ and mental health

The Governing Body NOTED the Chair’s Report.

GB18/19 135 Chief Executive Report Mr Sanders presented the Joint Chief Executive’s Report and took the report as read and thanked the Governing Body for their warm welcome. During his first week he had held a staff briefing with both CGG staff and NELCSU staff which was an important thing to do as he wished to strengthen the “one team” approach. He commented that he was keen to change the format of his report in that there would be a focus on items which were not included on the agenda.

Mr Sanders highlighted that his key priorities areas were supporting staff and strengthening teams, improving and building capacity and capability along with partnership working with the CCG’s membership, stakeholders and health and social care partners. He acknowledged the huge workload being undertaken by the Executive Team and commented that he would be strengthening the team going forward. He thanked Mrs Moody and the NELCSU Procurement Team on their response to the Allied Healthcare service situation in that swift action was undertaken in the re-procurement of the End of Life Service in order to safeguard patients. He reported that Marie Curie had been awarded the contract for the End of Life service.

The Governing Body NOTED the Chief Executive Report.

GB18/19 136 Questions from Members of Public Dr Watt read out 2 questions received from a member of the Save Corby Urgent Care Action Group and the CCG’s response.

Question1. Communications and Engagement Strategy 2018-19, whilst a communications and engagement strategy is very welcomed to ensure that this time engagement is completed within legal requirements, we find the whole document very patronising and paternalistic especially the first few paragraphs which outline major barriers but then do not give solutions on how those specific barriers will be overcome and what resources will be used? Given the outcomes of the Engagement of patients of the Corby last year it seems none of the lessons learned on that “engagement” have been learned or a commitment on how you will use the requirements of S.14Z2 Public involvement and consultation legislation to meet the needs of patients and carers inthe future.

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Whilst it is understood that this is a corporate strategy including the wider needs of the community including clinicians and other key stakeholders, the Action Group feels it needs much more work for it to meet the needs of the community of Corby, which should focus more on the outcomes rather than inputs and outputs as outlined within the strategy. Please would you therefore look to using the expertise of the group to make changes to this document? Answer1. We are keen to increase public understanding about NHS structures and the role of healthcare commissioning. We are aware that people care deeply about the direct care they receive, and we need to make sure we also commission care for the wider population needs. Effective delivery of engagement activity through this strategy will help to raise awareness of the work of the CCG. The group has correctly identified that this is a corporate strategy including the wider needs of the community including clinicians and other key stakeholders. We will be engaging with representatives of our population, and will ensure that we have heard the voices of a diverse representation of people within our population and understood their needs. This will include engagement with a wide range of community groups as part of this work. We are happy to receive direct correspondence from the group outlining their particular areas of expertise in order to best inform our team as to where this may be best utilised Question2. Commissioning intentions please could you inform us when the tender for both the new Urgent Care Centre and the GP extended access has or will commence and finish as this had not commenced when the group last asked this question? Answer2. The CCG can confirm that the procurement of both the Urgent Care Centre (25 October) and GP Extended Access (29 November) have commenced. Given the CCG is in a live procurement phase, it is unable to make further comment.

GB18/19 137 Governing Body Assurance Framework Mrs Follis presented the Governing Body Assurance Framework (GBAF).

Mrs Follis reported on progress against key actions in mitigation of the strategic risks for the CCGs. She attended the Clinical Commissioning Leaders Group meeting on 4 December 2018 to undertake an organisational development session on the GBAF. The aim of the session was to ensure that the clinical leadership for the organisation had the oversight of the purpose and development of the GBAF and she confirmed that this prompted further debate on how clinical input could be achieved. It was noted that there had been no risks added or removed since the last update provided to the Governing Body. The Directorate Risk Registers across the CCGs had been reviewed, aligned and updated as part of the implementation of the risk management process. Progress had been made on the development of the risk registers with identified Directorate Risk Leads, which had been co-ordinated by the Corporate Affairs Team. Finalised Directorate Risk Registers were in the process of being uploaded to the 4Risk System, which was the web-based system the CCGs would use to record risk management moving forwards. Mrs Follis confirmed that training had been arranged for all Risk Leads on how to access and use the system and it would be the responsibility of individual risk leads to complete the required updates to the Risk Registers. Dr Jones and Mrs Wightman commented on the residual risks which were red and Mr Hammond requested that he wanted to see more movement. Mr Sanders stated that the CCGs were averagely benchmarked and that focus needed to be on what the CCGs could undertake and influence.

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Mr Hammond enquired if reference to the risk position of Brexit and also the emerging risk position for Northamptonshire County Council needed to be included in the GBAF. Mrs Follis confirmed that she would be meeting with the Executive Risk Leads to review these risks to ensure that these were accurately and appropriately recorded within the GBAF. The Governing Body NOTED the Governing Body Assurance Framework.

GB18/19 138 NHS Long Term Plan update Ms Grobet presented the NHS Long Term Plan update and reported that publication of the NHS

Long Term Plan alongside 2019/20 Operating Planning guidance and 5 year allocations were still awaited. The Governing Body NOTED the NHS Long Term Plan update.

GB18/19 139 NHS Corby CCG and NHS Nene CCG Operational Plan Ms Grobet presented the NHS Corby CCG and NHS Nene CCG Operational Plan update and took

the paper as read. Ms Grobet reported that the 2019/20 planning guidance and templates were awaited, however in preparation, a multi-disciplinary team comprising representation from Commissioners; Business Intelligence; Performance; Finance; Contracting; and Programme Management Office had been established to oversee the development of the activity, financial and performance plans that comprise the “operating plan”. Work had started to establish the baseline position for the 2019/20 plans. Mr Sanders commented that more collective and aligned working was being undertaken with system Chief Executives, Chief Finance Officers and Contracting Leads. Dr Jones reported that HealthWatch England had received some funds from NHS England (NHSE) to carry out some engagement once the plan had been published. The Governing Body NOTED the NHS Corby CCG and NHS Nene CCG Operational Plan.

GB18/19 140 NHS Corby CCG Communications and Engagement Strategy Mrs Moody presented the NHS Corby CCG Communications and Engagement Strategy and she

took the paper as read. Mrs Moody reported that this Strategy was an updated version of the CCG’s Communications and Engagement Strategy, which sets out the key objectives and principles of communications and engagement work. It outlined the methods through which the Strategy would be delivered and identified potential risks and how the Strategy would mitigate them. Mr Youdale reported that the Strategy had been refreshed to reflect the integration of Corby CCG and Nene CCG, collaboration arising from the Northamptonshire Health and Care Partnership, and the adoption of strategic commissioning. The one-year term of this Strategy reflected the intention to develop a new, fully combined joint Strategy for Nene CCG and Corby CCG. Mr Sanders commented that it was a good strategic piece and set out the aims and objectives. He suggested that the second paragraph of the introduction section could be improved on. Action: Mr Youdale Mr Sanders assured the Governing Body that the Executive Team now had communications and engagement as a standing item on their weekly agenda. He stressed the need to focus on hot topics, linked back to planning and engagement with Clinicians. After discussion the Governing Body approved the Strategy.

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The Governing Body APPROVED the NHS Corby CCG Communications and Engagement Strategy.

GB18/19 141 Quality and Safeguarding Report Mrs Jamson presented the Quality and Safeguarding Report.

Mrs Jamson reported that the Quality and Safeguarding report had been presented to, and approved by, the NHS Corby CCG and NHS Nene CCG Joint Quality Committee on 11 December 2018. Mrs Jamson highlighted key areas of note which included concerns raised across the health economy regarding the Multi Agency Safeguarding Hub (MASH) and how the service had been monitoring referrals against the threshold, given the number of No Further Action (NFA) recorded. Ofsted carried out an inspection of the “front door” MASH in October 2018 and the outcome of this focused visit identified two key areas for priority action; workforce capacity and case allocation and progression. A priority plan was required to be submitted to Ofsted within 70 working days of receipt of the letter (13 November 2018). The Governing Body were informed that within the system there was a growing level of concern from both children and adult providers regarding the impact of the cost saving schemes required to meet the financial challenges faced by Northamptonshire County Council (NCC). In addition, concerns had been raised through NCC regarding the impact currently been seen in relation to Safeguarding duties and statutory responsibilities. The CCG also had concerns regarding the lack of consistency in the senior management structure. Mrs Jamson was pleased to confirm that the CCG had funded two additional safeguarding posts. She confirmed that there were a number of social worker vacancies which were being reviewed. Mrs Jamson reported that in regard to Thames Ambulance Service Ltd (TASL) a risk summit led by NHSE was called on 8 November 2018 in response to concerns identified at a recent CQC inspection and subsequent conditions that had been placed on the providers CQC registration. The four main areas of concern identified were; staff training, infection control issues, transport of children, bariatric patients or patients with mental health issues and governance. Regular oversight meetings had been arranged with the latest held on 27 November 2018. A cross county quality improvement plan had been developed by TASL with identified improvements included in the recovery action plan. The Governing Body were informed that there would be a change in style of reporting in that only points of escalation would be reported on with a link to the full report. Mr Sanders commented that this would also be similar to some of the other reports that were presented to Governing Body. Professor Fernando commented on the number of Never Events at Northampton General Hospital (NGH) and asked what processes had been put in place. Mrs Jamson gave assurance that the WHO check list was being used and that the Medical Director had introduced new training which had been undertaken. She confirmed that members of the Quality Team had carried out a visit and that they were assured. The Governing Body NOTED the Quality and Safeguarding Report.

GB18/19 142 Performance Report Mrs Moody presented the Performance Report and took the report as read.

Mrs Moody provided an overview of performance for Corby CCG and Nene CCG and informed the Governing Body that the report had been presented to the Joint Finance Committee and the Joint Quality Committee.

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She highlighted that key areas to note were that A&E remained below target for both Acute Trusts. In September Kettering General Hospital (KGH) declined from 89.26% in August to 83.29%. Northampton General Hospital (NGH) performance also had a slight decline in September from 91.55% in August to 88.98%. Un-validated data for October showed KGH at 87.1% and NGH at 86.5%. With regard to Cancer during August 2018, NGH had failed to meet the 2 week wait, 2 week wait breast and 62 day GP referral to treatment targets. She confirmed that they had a recovery plan in place to recover 2 week wait performance. NGH failed to meet the 62 day standard for the fifth month in succession. It was noted that the Planned Care Team, Contracting Team and Performance Team were concerned about the lack of pace relating to improvement by NGH across these standards and had requested a detail recovery plan and continued to work with the Trust to support improvement. KGH had achieved all cancer standards for August. An overall system Delayed Transfer of Care (DTOC) at 8.2% was well above the 3.5% target and currently, stranded and super stranded patient numbers had reduced significantly. System improvements were delivered through 7 delivery groups focusing on improving A&E performance and improving occupancy rates. Mrs Moody commented that the DTOC story was testament to a lot of hard and detailed work which demonstrated good working together as a system. The Governing Body NOTED the Performance Report.

GB18/19 143 Referral to Treatment Update Ms Grobet presented the Referral to Treatment Update.

Ms Grobet provided an update which showed the performance for Corby CCG against the Referral to Treatment (RTT) standard; the numbers of patients waiting over 52 weeks for elective treatment; and an update on the future governance and oversight arrangements for planned care in Northamptonshire. KGH’s performance against the RTT standard (i.e. 92% of patients to start treatment within 18 weeks of referral) saw a further slight deterioration in September 2018, to 81.77% (against an England average of (86.77%). In September, there were no patients waiting over 52 weeks from referral to treatment. Ms Grobet reported that Terms of Reference had now been reviewed for a county-wide Planned Care Board. The primary focus would be on access, availability and quality of service and the Board would look at RTT performance and be responsible for collaboratively producing plans that help improve RTT pathways and the quality of planned care for patients. Miss Brodrick commented that in the front sheet section ‘Quality & Equality Impact Assessment’ – ‘no adverse findings/not relevant’ had been selected however she could not find reference in the report to substantiate this. Ms Grobet confirmed that she would ensure that assurance was provided in future the report. Action: Ms Grobet Mr Sanders commented that he had received positive feedback from conversations with NHSE. The Governing Body NOTED the Referral to Treatment Update.

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GB18/19 144 Urgent and Emergency Care Report Mrs Moody presented the Urgent and Emergency Care Report and took the report as read.

Mrs Moody informed the Governing Body of the current performance position within the Acute Trusts and the actions undertaken across the system to support performance improvement focusing particularly on stranded patients and delayed transfers of care through the expedited discharge programme. She commented that the format of the report had changed and she hoped it was more user friendly with a glossary at the rear of the report. She reported that following on from a telephone call with national leads both Trusts had continued not to reach the 98% target and bed occupancy (96%-98%) was less comfortable that it should be but better than last year. Mrs Moody confirmed that winter reporting had commenced with performance and escalation status and the Winter Plan had been implemented. Mr Sanders commented that he would be discussing with the Executive Team on the way information was fed into reports and the need to refocus on key areas for discussion in order that key items were highlighted. The Governing Body NOTED the Urgent and Emergency Care Report.

GB18/19 145 Finance Transformation and Savings Report 2018/19 Month 7 Mr Rees presented the Finance Transformation and Savings Report 2018/19 Month 7.

Mr Rees took the report as read and provided a summary of the CCG’s latest financial performance as at month 7 and details of the in-year savings plans. He also highlighted the financial risks facing the CCG which might impact the financial position of the CCG in future months. He confirmed that the Corby CCG achieved the year to date control total of breakeven at month 7 and were forecasting for this to continue throughout 2018/19. However the CCG was continuing to experience cost pressures in continuing healthcare budgets and on prescribing budgets. It should be noted that the cost pressure on Cat M drugs forecasted for the remainder of the year had reduced at month 7 due to a non-recurrent national price reduction on Cat M drugs from November onwards. This was a non-recurrent price reduction and so had not reduced the impact on 2019/20 budgets. The Governing Body NOTED the Finance Transformation and Savings Report 2018/19 Month 7.

GB18/19 146 Request for delegation for approval of the Annual Report and Annual Accounts 2018/19 Mr Rees presented the Request for delegation for approval of the Annual Report and Annual

Accounts 2018/19. Mr Rees reported that the Governing Body was requested to delegate authority to the NHS Corby CCG Audit and Risk Committee to approve the draft and final NHS Corby CCG Annual Report and Annual Accounts covering the period 2018-19. The draft Annual Report must be submitted by 18 April 2019 and the draft Annual Accounts by 24 April 2019. The final Annual Report and Annual Accounts must be submitted by 29 May 2019. The Governing Body APPROVED the Request for delegation for approval of the Annual Report and Annual Accounts 2018/19.

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GB18/19 147 NHS Corby CCG Constitution Mrs Follis presented the NHS Corby CCG Constitution.

Mrs Follis reported that as part of the transition programme and working closely with NHS England, draft amendments and submissions of both NHS Nene and Corby CCGs’ Constitutions were submitted to NHSE for formal approval. The Governing Body met on 24 July 2018 where the Constitution was approved and submitted to NHSE. She reported that NHSE had now formally approved the amendments to the Constitution and Terms of Reference and a formal letter had been received by the CCG on 29 October 2018. Mrs Follis confirmed that the formal letter referred to as Appendix 1 would be circulated after the meeting. Action: Mrs McKenzie The Governing Body NOTED the NHS Corby CCG Constitution.

GB18/19 148 Northamptonshire Health and Care Partnership Board Report Mr Sanders presented the Northamptonshire Health and Care Partnership Board (NHCPB) Report

and took the report as read and commented that the report had been submitted to the Boards of all organisations within the Northamptonshire Health and Social Care Partnership. Key items included in the report were: • Mission and Vision Statement • Transformation Priorities • Stroke Pathway • Health and Wellbeing Social Prescribing Update • Collaborative Stakeholder Forum • Signposting of services across Northamptonshire Mrs Harper suggested that it might be an idea to have a presentation at a future meeting on the Primary Care Workstream by the Executive Sponsor and Dr Watt commented that this could be of interest. The Governing Body NOTED the Northamptonshire Health and Care Partnership Board Report.

GB18/19 149 Public Health Update Mrs Wightman presented the Public Health Update.

Mrs Wightman took the report as read and highlighted key areas to note. She informed the Governing Body that this year’s annual report was currently in development and would go back to basics by refocusing on the health inequalities that exist for those who live and work in the county. This report would be published in March/April 2019. Public Health ‘Plans on a Page’ had been completed for the top 10 Global Burden of Disease risk factors and consists of a ‘Call to Action’ data summary and Public Health high level strategic approach. The Governing Body NOTED the Public Health Update.

GB18/19 150 Governing Body Assurance Framework – Focus Review Mrs Follis explained that the focus review on the GBAF was a reflection period on any additions,

deletions or areas where members would wish to seek further assurance. Miss Brodrick enquired how Brexit would be fed into the GBAF and Mrs Follis responded that it could either sit across all the strategic risks or be a specific risk. She would also need to review where it sat across the Corporate Risk Register. After discussion the Governing Body agreed that Brexit should be a specific risk and Mrs Follis would action accordingly. Action: Mrs Follis

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GB18/19 151 Highlights from the Audit and Risk Committee Dr Watt informed the Governing Body that moving forward the Sub-Committee Highlight reports

would be included in the papers and therefore would not be a verbal item. Mr Hammond gave a verbal update from the Audit and Risk Committee meeting which took place on 20 November 2018 which was the first meeting in Common with NHS Nene CCG. Key agenda items • Financial Planning and Commissioning Audit Actions Report • Internal Audit reports and action clearance • Governing Body Assurance Framework • Committee requested Internal Audit review the role and remit of the Patient and Public

Engagement and Assurance (PPEA) Committee in relation to issues raised in the Judicial Review and by questions sent to the Governing Body by the Save our Urgent Care Group and the Committee were satisfied with the key findings.

Key areas of discussion arising from items appearing on the agenda • Urgent need to articulate clear strategic direction and vision Any key actions agreed/decisions taken to be notified to the Governing Body • Further deep dives for February into Planning process, and Patient and Public Engagement • Further actions to strengthen organisational capability and capacity • Reassured but not assured in respect of Commissioning Intentions and possible qualified

opinion from Internal Audit.

Any issues of risk or gap in control or assurance for escalation to the Governing Body • Committee assurance has historically focused on operational areas and which needed to be

extended to provide assurance on strategic direction. The Governing Body NOTED the Highlights from the Audit and Risk Committee.

GB18/19 152 Highlights from the Council of Members Dr Spencer gave a verbal update from the Council of Members which took place on 20 November

2018. Key agenda items • Regular Finance updates – patient transport services, allocation increase in principal but

council spend was a risk • MSK – hot topic with various issues around workflow and what benefit it was bringing • Prescribing update – repeat prescription project Key areas of discussion arising from items appearing on the agenda • MSK issues • Prescribing over the counter medications – good support

The Governing Body NOTED the Highlights from the Council of Members.

GB18/19 153 Highlights from the Joint Finance Committee Mr Rees gave a verbal update from the Joint Finance Committee meeting which took place on 4

December 2018.

Key agendas items • Monthly Finance and Integrated Performance Reports • Medium Term Financial Plan

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• A&E Activity trends • Contract Risk Register • Procurement Highlight report • Corby RightCare Complex Patients Key messages from items discussed • QIPP Gap For 18/19 • Requirement for more insights and timely information • Allied Healthcare concerns • Thames Ambulance Service Ltd situation • Systems wide co-ordination and planning for 2019/20 and beyond

Key actions agreed/approved • Contract list to be published on CCG websites • Contract renewal dates to be made visible • A&E activity trend RAG rating needed to be objective and quantative Key risks or gaps in control or assurance • QIPP delivery in both 18/19 and 19/20 • Limited assurance around key provider performance The Governing Body NOTED the Highlights from the Joint Finance Committee.

GB18/19 154 Highlights from the Primary Care Commissioning Committee Mrs Harper gave a verbal update from the Primary Care Commissioning Committee meeting which

took place on 27 November 2018. Key Agenda items • Finance Update • NHSE Update • Assurance of economic and financial standing • Primary Care Quality Report – no update due to incompatible meeting/reporting cycle • Workforce Group • Risk Register Key areas of discussion arising from items appearing on the agenda • Finance update – concern regarding overspend in GP prescribing remaining a challenge in

coming years when picking up full costs and consequential impact on budget • Secured £350k for GP attraction and retention scheme • Estates strategic business cases now managed through countywide NH&CP • Workforce update, keen interest in the apprenticeship level. Any key actions agreed/decisions taken to be notified to the Governing Body • Committee to continue to take keen interest in building up appropriate estate in Primary Care

in Corby especially considering the huge expansion in population The Governing Body NOTED the Highlights from the Primary Care Commissioning Committee.

GB18/19 155 Highlight Report from the Joint Quality Committee Mrs Dempsey gave a verbal update from the Joint Quality Committee which took place on 11

December and reported that key items had already been discussed under the ‘Quality and Safeguarding Report’ agenda item. She confirmed that the Terms of Reference had been approved and a new Risk Register introduced.

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The Governing Body NOTED the Highlights from the Joint Quality Committee.

GB18/19 156 Highlights from the Joint Transition Board Mr Harper gave a verbal update from the Joint Transition Board meeting which took place on 22

November 2018. Key agendas items discussed were • Communication and Engagement strategy • Risk Register • Staff Forum update. • Timing of the OD Strategy

Key agendas items discussed were • NHSE 10 year plans would inform future strategy • Many of current strands of current Transition Board work and associated risks needed to be

managed at Executive level. • It was recommended that a Memorandum of Understanding was not required at this moment

in time. • The Committee handbook was recognised as an excellent summary of the current CCGs’

governance structures and it was approved. • Staff forum was slowly developing Any key actions agreed/decisions taken to be notified to the Governing Body • Time for reflection of what is needed with regard to the CCGs future strategy and the skills and

experience needed within the Executive team • The Committee recommended that the Communication and Engagement plan and also the OD

plan would need further consideration. Any issues of risk or gap in control or assurance for escalation to the Governing Body • The Executive Team needed to be expanded and portfolios clarified to ensure it was ready and

able to take the future strategy forward from January. The Governing Body NOTED the Highlights from the Transition Board.

GB18/19 157 Joint Executive Management Team Mr Sanders confirmed that key items had already been addressed throughout the agenda.

The Governing Body NOTED the Highlights from the Joint Executive Management Team.

GB18/19 158 Sub-Committee Minutes for Information The Governing Body noted the following approved sub-committee minutes:

• Joint Executive Management Team 2 October and 6 November 2018 • Audit and Risk Committee 18 September 2018 • Council of Members 18 September 2018 • Joint Finance Committee 2 October and 6 November 2018 • Primary Care Commissioning Committee 20 September 2018

The Governing Body NOTED the approved sub-committee minutes.

GB18/19 159 Health and Wellbeing Board Minutes The Governing Body noted the minutes from the Health and Wellbeing Board meeting held on 13

September 2018.

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GB18/19 160 Key Messages from the CCG Governing Body Meeting Dr Watt summarised the Key Messages which the Governing Body noted:

• Note the approval of the Communications and Engagement Strategy • There was significant work underway with regard to improving safeguarding and how working

as a system to ensure that adults and children get early help was important. • Good news about the improved Delayed Transfers of Care position and successful

procurement of the End of Live Services • Improved working together as a system.

The Chair requested that the Governing Body passed a resolution to move into a meeting in private to consider private items of business. The Governing Body APPROVED the resolution. Date and Time of the next meeting The next Governing Body meeting in public would be held at 09:30 on Tuesday 26 February 2019 in Meeting Room 1, Corby Enterprise Centre London Road, Priors Hall Corby NN17 5EU. Dr Watt brought the meeting to a close at 12:10

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A C T I O N L O G

NHS Corby CCG Governing Body Meeting in Public Updated 4 February 2019

Minute No: Agenda Item Action Lead Status/Update Timescale RAG

18 December 2018 GB 18/19 150 Governing Body

Assurance Framework (GBAF) – Focus Review

Brexit to be a specific risk. Emma Follis The GBAF has had a full Executive review including consideration of the risk around Brexit. Further details are in the report presented to Governing Body on 26 February 2019.

January 2019

GB18/19 147 NHS Corby CCG Constitution

Appendix 1 formal letter from NHSE to be circulated. Sarah McKenzie Circulated to Governing Body members. December 2018

GB18/19 143 Referral to Treatment Assurance to be provided in the front sheet regarding Quality & Equality Impact Assessment.

Bie Grobet Actioned – communicated to report writer January 2019

GB18/19 140 Communications and Engagement Strategy

Second paragraph of the introduction section to be improved on. Matt Youdale Actioned - Amended version signed off by Executive Director.

January 2019

Completed On Track Overdue No further action

16

Report To


Date of Meeting


Title of the Report

Chief Executive’s Report

Agenda Paper Reference No:

GB-19-03

Presenter of Report Toby Sanders Chief Executive NHS Corby CCG and NHS Nene CCG

Author(s) of Report

Kate Barker Deputy Director of People, Partnership and Integration NHS Corby CCG and NHS Nene CCG Neil Boughton Deputy Director of Corporate Affairs NHS Corby CCG and NHS Nene CCG Alison Jamson Deputy Director of Quality NHS Corby CCG and NHS Nene CCG Julie Lemmy Deputy Director of Primary Care NHS Corby CCG and NHS Nene CCG Giles Owen Deputy Director Prescribing and Medicines Management NHS Corby CCG and NHS Nene CCG Jane Taylor Deputy Director of Urgent Care NHS Corby CCG and NHS Nene CCG

Executive Director Sponsor

Toby Sanders Chief Executive NHS Corby CCG and NHS Nene CCG

17

Purpose of Report

Please select:

☐ Approval ☒ Note

☐ Ratification ☐ Information

☐ Assurance ☐ Update

Executive summary A general overview of local and national NHS activity. Related Corporate Objectives Please select:

☒ Quality ☒ Commission sustainable services

☒ Transformation ☒ Workforce and Culture

☒ Engagement ☒ Accountability

Related CCG Framework Domain

Please select:

☐ Better Health ☐ Sustainability ☐ Better Care ☒ Leadership

Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? No

Governing Body Assurance Framework

Please select: ☐ GBAF01 The CCGs fail to deliver their statutory duties ☐ GBAF02 The CCGs are not able to deliver against the

national mandate and Northamptonshire Health Care Partnership work stream for Strategic Commissioning

☐ GBAF03 The CCGs fail to commission appropriate safe, effective and quality services that are sustainable

Conflicts of Interest Please select: ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in

discussion but not in decision ☐ Conflict noted, conflicted party can remain but not

participate ☐ Conflict noted, conflicted party leave for the discussion and

decision

Quality & Equality Impact Assessment

Please select: ☒ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be

addressed ☐ Continue regardless: Benefits outweigh risks and continuing

would not constitute unlawful discrimination ☐ Stop: Risks outweigh the benefits, including being open to

legal challenge

18

Engagement • Patient and Public • Clinical

Y

Legal implications / regulatory requirements

Are there any significant issues with legal compliance? N

Recommendations

The Governing Body is asked to: • Note the Chief Executive’s report

19

Chief Executive Officer’s Report February 2019

1. Introduction This report summarises the latest CCG news, developments, upcoming events and national guidance and policy updates and includes information on: 2. CCG Directorate updates 2.1 Corporate Affairs Team The Governing Body are asked to note that the following public message regarding Governing Body meetings is now displayed on the NHS Corby CCG and NHS Nene CCG websites. Since their inception NHS Corby Clinical Commissioning Group and NHS Nene Clinical Commissioning Group (collectively known and the Northamptonshire CCGs) have had a long standing history of collaborative working. Over the past 12 months the CCGs have made significant progress in moving towards a joint operating model to further enhance the value and quality of services commissioned on behalf of the population of Northamptonshire, and drive the efficiency of internal operations. The CCGs are seeking to build upon this work further over the next 12 months and as such have agreed to streamline Governing Body Meeting arrangements. The CCGs have agreed that as of April 2019 the two Governing Bodies will hold their meetings together in what is known as a Committee in Common format. In addition to this, it has been agreed that the Governing Bodies Meetings in Common in Public shall be conducted on a bi-monthly basis. As in previous years the 2018 NHS Staff Survey has been administered by the Picker Institute. NHS Corby Clinical Commissioning Group and NHS Nene Clinical Commissioning Group did for 2018 collectively commission the Picker Institute to undertake the local survey to enable all employees of both CCGs to participate in a single staff survey. Initial feedback from the Picker Institute highlights that of the 142 staffs eligible, 103 provided a response to the survey. This represents a collective response rate of 72.5% compared to a national average CCG response rate of 79.1%. We anticipate being in receipt of the final survey report, inclusive of analysis at the local level, toward the end of the financial year where it will be reported to the Joint Executive Management Team and Governing Body along with an action plan. 2.2 Quality and Safeguarding Team Most successful gang intervention comes to Northamptonshire: The most successful gang intervention programme which has seen huge reductions in gang violence in Cincinnati, Boston and Glasgow has come to England for the first time in Northamptonshire. The Community Initiative to Reduce Violence (CIRV) is a multi-agency project designed to reduce gang violence, not necessarily by locking gang members up, but by working with them to show them the consequences of the life they are choosing to lead and showing them an alternative pathway through mentoring, support, job opportunities and other change programmes. Anyone can refer into CIRV - whether that be someone who needs help themselves to get out of ‘gang life’ or someone who is concerned about someone they know. Research article published on local Care Homes Training: Health Education and Care has published a research article following the evaluation of positive outcomes achieved from the care homes training developed by the CCGs’ quality team. The paper evidences improved quality outcomes and cost efficiencies made following implementation of the Frail Older Peoples Toolkit Training. This work has also proved a successful QIPP. 2.3 Partnerships, People and Integration Directorate The CCG has successfully bid and received funding for the development of accessible end of life advanced planning materials for people with Learning Disability. The funding will also be used to train providers and families to use tools to support the process of planning.

20

The Childrens Health and Care Partnership and Local Maternity System have been successful in their application to be part of the NHS Improvement Transformational Change through System Leadership (TCSL) programme. This fully funded programme provides access to expert, professional support and peer groups from healthcare systems across the country. It is targeted at teams of senior leaders who are working on a transformational change as part of an STP or ICS work programme. The Northamptonshire team has representation from the Local Authority, Police, Ketttering General Hospital (KGH), Public Health, Northamptonshire Healthcare Foundation Trust (NHFT) and the CCGs, and starts the training in February. Children and Young People On 17 January 2019 the CCGs Facilitated a workshop to discuss existing pathways, provisions and interfaces for children who may or may not have Autism, but who have behaviours that challenge and experience difficulties across both school and home settings. As a consequence, some of this cohort appear to revolve around the system, with no clear direction of the pathways and services that would most benefit them. The workshop brought together a number of colleagues and stakeholders from across the county including representatives from NHFT, Northampton General Hospital (NGH), Northamptonshire County Council (NCC), Public Health and the Office of the Northamptonshire Police, Fire and Crime Commissioner. Presentations were delivered to share information on current service offers, followed by a focused discussion on potential solutions to the difficulties being faced by the system in meeting the needs of this cohort. The workshop was well received, and the CCGs are in the process of compiling notes from the workshop for circulation to those who attended, alongside wider system partners, and considering next steps for the proposed solutions that can be shared and taken forward with those partners in the future.

Better Care Fund The CCGs have reported that Northamptonshire has met all the performance targets for the 3rd quarter of 2018-19 including:

• Reduction in non-elective admissions • Rate of permanent admissions to residential care homes • Proportion of older people (65 and over) who were still at home 91 days after discharge

from hospital into reablement/rehabilitation services • Delayed Transfers of Care

2.4 Urgent Care Team Brexit The Northamptonshire CCGs are working with Northamptonshire providers of NHS funded care to plan and mitigate for the potential scenario of a no deal EU exit. We are also working alongside multi-agency colleagues to ensure that Northamptonshire is as prepared as possible. National mitigation will be provided for a number of key areas including medicines and clinical and non-clinical consumables MiDoS This is an application designed to assist health and social care professionals to get patients seen by the right clinical expertise at the right time. It achieves this by searching a variety of service directories, including the NHS Pathways Directory of Services (DoS), Local Authority, and Voluntary Sector. It will also provide an access portal to public facing sites and portals, to allow members of the public to easily obtain local service information from a ‘Single Source of Truth’. This will increase patient awareness of services, and to get meaningful data around which services patients are using, and what key terms are searched most frequently. The application offers a range of searching options which can be configured to suit local preferences and operational requirements. It provides buttons to quickly find particular service types or specialties, but also gives a more in-depth Clinical search where this is prioritised locally. Several programmes across the NHS are also using MiDoS to capture and share live capacity and availability or beds and services. Where such information is being collected, it is incorporated into the results information displayed.

21

The programme supports the Northamptonshire STP Urgent Care objectives and delivery of the 10 high impact changes by enabling active signposting, care navigation, social prescription and self-management. 2.5 Prescribing and Medicines Management Team It has been estimated that the NHS spends £569M/year on prescriptions for medicines available “over the counter” (OTC) and that a significant proportion of this prescribing is for conditions which are self-limiting, or suitable for self-care. Following an extensive public consultation process NHS England (NHSE) have issued guidance to CCGs recommending that OTC items should not be routinely prescribed for such conditions. This comprehensive guidance from NHSE also recommends situations when it may be appropriate for clinicians to prescribe e.g. severe cases, patients with limited ability to self-manage due to medical, mental health or significant social vulnerability. Northamptonshire CCGs have decided to implement NHS England’s guidance as it anticipated it will reduce expenditure on OTC items as well as “freeing up” appointments at GP practices for patients with significant health care issues. 2.6 Primary Care Team Estates A Health Planner with local authority knowledge & experience will be in post in April 2019. This post will provide the Northamptonshire CCGs with much needed expertise in the local authority planning process in Northamptonshire and ensure that we maximise all existing and future Section 106 contributions* (*Funding from planning applications i.e. developers contributions used for health care services) . The Health Planner will be embedded into the primary care team and will work across the 7 Local Authority areas and will have links with public health and other colleagues in the county. The CCGs have been successful in securing further funding from the Estates, Technology & Transformation Funding programme to secure further professional expertise in the development of the Primary Care Estates Plan which will support the development of the emerging Health Care and Integrated Care service model (being developed by the Primary Community & Social Care work stream). GPFV Workforce The CCGs have been set challenging General Practice Forward View (GPFV) workforce targets by NHS England, therefore several programmes are underway not only to increase numbers in the workforce, but retain the practice teams we currently have.

Locally to boost practice nurse numbers a General Practice Nurse training post pilot was launched by the CCGs in December after securing over £170k from NHS England/Health Education England to pump prime these roles. A recruitment event saw over 30 applicants from nurses for the 10 post available, all of which have now been filled through a countywide collaborative recruitment drive hosted by the CCG in partnership with 3Sixty and Lakeside.

In January the Department of Health and Social Care (DHSC) sought to undertake a ‘Deep Dive’ into general practice workforce across Corby CCG. On the 24 January three Corby practices and the CCG GPFV workforce lead met with the DHSC and presented some of the workforce successes and initiatives underway alongside challenges and recommendations that the DHSC could enact at a national level.

Finally over £100k of funding that was secured late last year from NHS England for attraction and retention has now been devolved to practices, federations and the Local Medical Committee (LMC). The funding has been allocated following a bidding process overseen by the CCGs Primary Care Workforce Group who has worked in partnership to ensure this is invested equitably across the county and to support a wide range of initiatives in general practice with practice managers, nurses, Health Care Assistants (HCAs) and GPs.

The next key project to be launched under the GPFV Workforce programme is international recruitment of GPs. Expression of Interests (EOIs) will be requested over the coming weeks and working alongside the LMC, branding and communications to promote Northamptonshire as an attractive place to live and work.

22

3. NHS National Update Lung cancer scanning trucks The East Midlands Cancer Alliance, which includes NHS Corby CCG, has been chosen as one of ten regions across the country to host a mobile cancer scanning truck. The mobile clinics, to be parked in supermarket car parks, are part of a £70 million national project to save lives by catching lung cancer early. Those most at risk will be invitied for an MOT for their lungs and an on the spot chest scan. The roll out has the potential to reach around 600,000 people over four years, detecting approximately 3,400 cancers and saving hundreds of lives across the country. The new projects will last initially for four years and NHS England will then evaluate the results to use as a basis for further roll out. Digital Minor Illness Referral Service pilot in the East Midlands A pilot scheme has been introduced in the East Midlands to enable people calling NHS 111 with minor illnesses to have appointments booked with a local pharmacist. The Digital Minor Illness Referral Service (DMIRS) is available to the public calling NHS 111 in Northamptonshire, Nottinghamshire, Derbyshire, Leicester, Leicestershire and Rutland, Lincolnshire, and Milton Keynes. The trial scheme will run until March 2019. NHS to provide life changing glucose monitors for Type 1 Diabetes patients Tens of thousands of people with Type 1 diabetes across the country will benefit from life changing NHS glucose monitors. The wearable sensor does away with the need for inconvenient and sometimes painful finger prick blood tests by relaying glucose levels to a smart phone or e-reader. NHS England will ensure the device, which is the size of a £2 coin and sits on the arm, is available on prescription for all patients who qualify for it in line with NHS clinical guidelines. NHS Long Term Plan and new GP contract Last month the NHS Long Term Plan announced the ambition to prevent 150,000 heart attacks, strokes and cases of dementia in England over the next ten years. The new GP contract is the first step in the implementation of the NHS Long Term Plan and shows how primary care will be transformed to help meet this ambition. Under the GP contract, new funding will allow local practices in England to work together in primary care networks, serving populations of 30-50,000. This will help primary care teams to collaborate; sharing staff and resources to ensure the best care for individual patients. It will also ensure the best outcomes for local populations while reducing growing pressure on GPs.

• Clinical pharmacists vital to patient care in five-year GP deal NHS England has also confirmed that pharmacists will take on an expanded role at the heart of local primary care networks across the country. Patients across England will be able to get faster expert advice about their prescriptions and other treatment, with clinical pharmacists as part of core practice teams. All clinical pharmacists will undertake additional clinical training, and work to deliver appropriate structured medication reviews, improve medicine safety, support care homes, and run practice clinics.

• Workers to support family doctors In addition to this NHS England also plans to recruit 1,000 social prescribing ‘link workers.’ The link workers will be able to give people time to talk about what matters to them and support them to find suitable activities that are a better alternative to medication as part of a step change in the provision of ‘personalised care.’ GPs surgeries big and small will work to support each other in around 1,400 Primary Care Networks covering the country, with each network having access to a social prescriber link worker and NHS England agreeing to fund their salaries in full.

23

Report To


Date of Meeting


Title of the Report


Agenda Paper Reference No:

GB-19-04

Presenter of Report Neil Boughton Deputy Director of Corporate Affairs NHS Corby CCG and NHS Nene CCG

Author(s) of Report

Emma Follis Corporate Services & Governance Manager NHS Corby CCG and NHS Nene CCG

Executive Director Sponsor

Stuart Rees Chief Finance Officer NHS Corby CCG and NHS Nene CCG

Purpose of Report

Please select:

☐ Approval ☐ Note

☐ Ratification ☐ Information

☒ Assurance ☐ Update

Executive summary The Governing Body Assurance Framework (GBAF) is presented to the NHS Corby Clinical Commissioning Group (CCG) Governing Body for assurance. This paper sets out the review and oversight work undertaken since the last update presented to the Governing Body in December 2018, including the outcomes of the Executive Review session held in January 2019. The Governing Body is asked to note the progress against key actions in mitigation of the strategic risks for the CCGs and progress of the development of the Corporate Risk Register. Detailed updates are included within the GBAF which is included at Appendix 1 to this report. Related Corporate Objectives Please select:

☐ Quality ☐ Commission sustainable services

☐ Transformation ☐ Workforce and Culture

☐ Engagement ☒ Accountability

24

Related CCG Framework Domain

Please select:

☐ Better Health ☐ Sustainability ☐ Better Care ☒ Leadership

Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? Yes


Please select: ☒ GBAF01 The CCGs fail to deliver their statutory duties ☒ GBAF02 The CCGs are not able to deliver against the

national mandate and Northamptonshire Health Care Partnership work stream for Strategic Commissioning

☒ GBAF03 The CCGs fail to commission appropriate safe, effective and quality services that are sustainable

Conflicts of Interest Please select: ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in

discussion but not in decision ☐ Conflict noted, conflicted party can remain but not

participate ☐ Conflict noted, conflicted party leave for the discussion and

decision

Quality & Equality Impact Assessment

Please select: ☒ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be

addressed ☐ Continue regardless: Benefits outweigh risks and continuing

would not constitute unlawful discrimination ☐ Stop: Risks outweigh the benefits, including being open to

legal challenge

Engagement • Patient and Public • Clinical

No

Legal implications / regulatory requirements

Are there any significant issues with legal compliance? No

Recommendations

The Governing Body is asked to: • Note the summarised updates on progress against key actions • Note the executive risk review undertaken for the Governing Body Assurance Framework

(GBAF) • Note the progress of the Corporate Risk Register and roll out of training for the 4risk system

25


1. Introduction

1.1. The Governing Body Assurance Framework (GBAF) is presented to the NHS Corby CCG Governing Body for assurance that the strategic risks for the CCGs (NHS Corby CCG and NHS Nene CCG) are being effectively managed and that key actions are being taken to mitigate the risks identified.

1.2. This paper sets out progress against key actions, summarised assurance updates and the updated GBAF included at Appendix 1 to this report.

2. GBAF review

2.1. At the time of writing this report there have been no risks added or removed since the last update provided to the Governing Body. The Governing Body is asked to note the detailed GBAF report included at Appendix 1 to this report, which is the first time the report has been provided from the CCGs’ web-based risk management system 4Risk. Summarised updates on the risks are detailed below.

2.2. A number of actions have been completed since the last update was presented,

these actions have now become key controls to mitigate the strategic risks these are listed below and are detailed as such within the GBAF: • Delivery Group established to provide oversight and monitor progress against

all key performance indicators • Quarterly assurance checkpoint process with NHS England to ensure Regulator

oversight and escalation as required • System plan developed, submitted to and monitored by Regulators, with CCGs’

response to Regulator challenge as required • QIPP plan development in line with commissioning plan – weekly meeting

between Directors of Strategy and Joint CEO, as system planning lead. • Surge and Capacity Plan and Winter Plan developed and being tested and

monitored via the Urgent and Emergency Care Transformation Programme Board (UECTPB)

• Contracting review process monitored via the Contract Strategic and Operational meetings, with escalation route identified.

• Director of Finance meetings – regular meetings established between Directors of Finance across the county

• Clinical Leaders Group providing input to the 2019/20 plan and oversight via the Joint Executive Management Team (JEMT)

2.3. GBAF01 - The CCGs fail to deliver their statutory duties

• The risk score for GBAF01 has been reduced from 16 (4x4) to 12 (4x3), this is as a result of the year end deal being agreed with the three main providers. There are also a number of key controls in place for the risk. However the score remains at 12, with the likelihood being reduced.

26

2.4. GBAF02 – The CCGs are not able to deliver against the national mandate and Northamptonshire Health Care Partnership Strategic Commissioning • The risk score for GBAF02 has been reduced from 16 (4x) to 12 (4x3). The

likelihood of the risk has been reduced due to the agreement of the year end deal with the three main providers and also the ongoing weekly meetings between Directors of Finance and Joint Chief Executive for NHS Corby CCG and NHS Nene CCG who is the nominated CEO for the system.

2.5. GBAF03 – The CCGs fail to commission appropriate, safe, effective and quality services that are sustainable • The risk score for GBAF03 remains at 16 (4x4), due to the residual risk in

relation to the identified and unidentified financial position. • There is an improved position of the controls in place for the development and

implementation of the new planning guidance issued for 2019/20, including the weekly meeting with system Directors of Strategy and the CCGs’ Joint Chief Executive which has been established for the design, delivery and system control of the process for implementation to ensure responsibility for other system priorities.

3. Updates on the key actions 3.1. Table 1 below details the key actions mapped against the strategic risks identified

within the GBAF, and provides summarised updates to demonstrate the actions undertaken by the Executive Risk Leads on behalf of the CCGs to mitigate the risks.

3.2. The Governing Body is asked to note that the Transition Board has now ceased and therefore is no longer listed as a key action within the table below.

27

Table 1 – Key actions against strategic risks

4. Progress on the implementation of the Risk Management Process

4.1. Further progress has been made by the Corporate Affairs Team with regards to the implementation of the Joint Risk Management Process. All Directorate Risk Registers have now been uploaded to the 4Risk system; this process has been supported by RSM UK.

4.2. The Directorate Risk Registers across the CCGs have been reviewed, aligned and

updated as part of the implementation of the risk management process and are now being managed via the 4risk system. Training has been provided for all Risk Leads on the system, with the responsibility for individual risk leads to complete the required updates to the risk registers. Training is also being offered to the wider Governing Body on the 4risk system during February.

4.3. Escalation of risks to the Corporate Risk Register has been undertaken and the Joint Corporate Risk Register was reported to the Audit and Risk Committees in Common on 7 February 2019.

4.4. As part of the review undertaken of the Directorate Risk Registers these have been

aligned to relevant Committees to which they provide assurance. All Directorate Risk Registers are being and will be presented for assurance to the Audit and Risk Committees in Common as part of the work planners for each of CCG Committees.

Action Action Owner(s) Risk

Action Update Action

Due Date GBAF01 GBAF02 GBAF03

Commissioning Plan

Director of Health Strategy and Planning

Triangulation and contract alignment process of joint system plans for 2019/20 underway with weekly Chief Executive Officer (CEO) meetings, reviewed by the Executive Team and finance review. Initial submission of the draft joint plan by 14 January 2019. Final submission due by 4 April 2019. All providers STP clinical leadership have validated the clinical priorities identified for 2019/20. We have moved into planning phase.

April 2019

Commissioning Intentions

Director of Health Strategy and Planning, Director of Contracting and Delivery

JEMT will continue to have oversight of this process and ensure that this is embedded for 2019/20. All providers STP clinical leadership have validated the clinical priorities identified for 2019/20, contained within the commissioning intentions. We have moved into planning phase.

March 2019

Communications and Engagement Plan

Director of Contracting and Delivery

Engagement activities for this year’s operational plan. Patient and Public Participation Committee (PPPC) socialising the required activities. Joint Engagement Strategy being developed for the CCGs for presentation by July 2019.

July 2019

Medium Term Financial Plan

Chief Finance Officer

Final submission of the Medium Term Financial Plan will be due by 4 April 2019. April

2019

Organisational Development Plan

Chief Finance Officer

Discussion held on Organisational Development (OD) Plan at Governing Body in Common in November 2018. Acknowledgement of alignment of OD plan and 5 year plan in line with planning guidance. For further review following decision on the CCG organisational form.

June 2019

Joint Strategic Commissioning Committee (JSCC)

Director of Health Strategy and Planning

Terms of Reference (TOR) were presented to the JSCC on 08 November 2018, however the meeting was not quorate and TOR not approved. Further review of corporate calendar to ensure quoracy of meeting including chair attendance, meeting planned for February 2019. The second hour of the Joint Quality Committee will be used by the Joint Strategic Commissioning Committee re-enforcing the quality drive through our commissioning decisions.

Feb 2019

28

5. GBAF Executive Review 5.1. Further to the presentation of the GBAF to the NHS Corby CCG Governing Body

meeting in December and NHS Nene CCG Governing Body meeting in January, Clinical and Non-Clinical Executives met on 31 January 2019 to undertake a detailed review of the GBAF to support: • Scale • Identification of risk, cause, effect • Identification of mitigating actions and effectiveness of progress made to

mitigate the risk The Executive Review session was attended by:

• Stuart Rees, Joint Chief Finance Officer • Kathryn Moody, Director of Contracting and Delivery • Caron Williams, Director of Health Strategy and Planning • Dr Nathan Spencer, GP Governing Body Member • Dr Sanjay Gadhia, GP Governing Body Member

The session was facilitated by Neil Boughton, Deputy Director for Corporate Affairs, and Emma Follis, Corporate Services & Governance Manager. Subsequent meetings have been held with Julie Curtis, Interim Director of Primary and Community Integration, Dr Matthew Davies, Medical Director, and Alison Jamson, Deputy Director of Quality, as Executive Risk Owners.

5.2. The Executive Review undertaken identified that the three strategic risks recorded on the GBAF are too wide reaching and do not allow clarity of risk ownership or the CCGs to see the effect of the mitigating actions on the individual risks. It was also recognised that the assurance detailed within the GBAF cannot be easily mapped to the relevant risks.

5.3. The proposed revised GBAF structure set out below will ensure that there are single executive risk owners, both managerial and clinical, providing the clarity required on risk ownership and will enable the CCGs to demonstrate the effectiveness of controls in place and identify key priorities.

5.4. At the time of writing this report a number of risk areas to strategic delivery have been identified to be included within the GBAF, these are: • Business Continuity • Statutory Duties – within this risk a number of sub-risks have been identified to

address specific risks in relation to achievement of delivery of statutory duties, these are: • Financial • Performance • Engagement • Delegated Commissioning • Access

29

• Safeguarding • Public Sector Equality Duty

• Quality Care/Performance/Safety • Delivery of the Primary Care Strategy • 19/20 Operating Plan • Long Term Plan • Change of organisational form within the system

5.5. The review session also identified that a number of causes can be mapped across a

number of the risks, therefore it is important that the narrative that sits alongside the GBAF demonstrates the link of these causes across the risks.

5.6. To ensure correlation of risks, the GBAF, Corporate Risk Register and Directorate Risk Registers have been triangulated to ensure that there is alignment of risks. The current GBAF risks, as detailed above, are being aligned to the new GBAF risks.

5.7. Following the Executive Review Session held, further individual risk review meetings are being undertaken with each Executive Managerial Risk Lead and identified Clinical Executive Risk Lead to ensure that the revised GBAF accurately and appropriately details the strategic risks, key controls in place, mitigating actions being taken and assurance lines against each risk.

6. Recommendations

6.1. The Governing Body is asked to: • Note the summarised updates on progress against key actions • Note the executive risk review undertaken for the Governing Body Assurance

Framework (GBAF) • Note the progress of the Corporate Risk Register and roll out of training for the

4risk system

30

Report Date 08 Feb 2019

Governing Body Assurance Framework (GBAF)

Page 1 of 11

31

1.GBAF

Risk Ref

Corporate Objective

Risk Title Cause & Effect Inherent Score

Risk Control Control Assurance (1st Line)

Control Assurance (2nd Line)

Control Assurance (3rd Line)

Overall Assurance Assurance

Level

Residual Score

Action Required Progress Notes Target Score


Page 2 of 11

32

1.GBAF

Risk Ref

Corporate Objective






Level

Residual Score


GBAF 1

1. Quality – We will improve quality within all providers to ensure services are safe, efficient and effective

The CCGs fail to deliver their statutory dutiesRisk Owner: Kathryn MoodyRisk Lead:Last Updated: 25 Jan 2019Latest Review Date:Latest Review By:Latest Review Comments:

Cause - Legislation is not keeping pace with NHS guidance. - Insufficient provision of quality services. - Financial sustainability of Partner Organisations. - The CCGs do not use information effectively to make evidence-based commissioning decisions. - Existing commissioning plan is not robust or fit for purpose. - Planning and evaluation is not undertaken effectively within the commissioning and contracting cycle. - Alignment with the local system and resources. - Workforce challenge not meeting the capability and capacity required. - Transition to alignment of the CCGs.Effect - Regulator intervention could lead to potential to have directions placed on the CCGs. - Legal action or judicial review. - Safeguarding concerns raised and potential impact on patient safety. - Inability to carry out transformation. - The CCGs are not able to demonstrate value for money. - Potential financial impact on commissioning of future services. - Patient experience is poor. - Outcomes compromised.

I = 5 L = 420

01. Integrated Performance Report (IPR) is produced monthly and presented to relevant Committees. IPR reviewed to ensure appropriate insights are provided/gained. Control Owner: Kathryn Moody

- Finance Team manage all financial and analysis reports. - Oversight via the 4action system of implementation of internal audit recommendations.

- Joint Finance Committee (JFC), Audit and Risk Committee (ARC), Joint Quality Committee (JQC) all provide assurance to the Governing Body that delegated responsibilities have been fulfilled. - Audit and Risk Committee in Common oversight of internal audit recommendations. - Governing Body assurance oversight and triangulation.

- Annual Internal Audit plan - Annual External Audit plan

Adequate

Assurance Date: 29 Jan 2019

Assurance By: Emma Follis

02. Business Discipline oversight – Delivery Group. Increased support from NELCSU. Provides oversight and monitors progress against all key performance indicators. Control Owner: Kathryn Moody

- Delivery Group established for oversight and tracking. Increased and enhanced coverage from NELCSU

- Reported to Executive Operational Group (EOG) on progress of delivery and development of integrated performance report

Adequate



03. Approved financial strategy and business plans.Control Owner: Kathryn Moody

- Performance meetings with providers for Performance Notice. - Finance Team undertake regular reviews.

- JFC receive regular updates and report into A&RiC.

- Annual Internal Audit plan. - NHSE regulator oversight. - Annual External Audit plan.

Adequate



04. Finance Team meet with budget holders monthly to manage financial oversight and control. Contracting and Performance Team meet with Providers via the Operational and Strategic meetings and ensure escalation process in place. Control Owner: Stuart Rees

- Finance Team - evidence of meetings and outcomes. - CFO works closely with QIPP delivery team.

- JFC receive regular updates and report into ARC.

- Internal Audit. - NHSE. - External Audit.

Adequate



I = 4 L = 312

16. Establishment of JSCC in line with CCGs’ governance arrangements.Person Responsible: CaronWilliamsTo be implemented by: 30 Nov2018

25 Jan 2019Emma FollisTerms of Reference (TOR) were presented to the JSCC on 08 November 2018, however the meeting was not quorate and TOR not approved. Further review of corporate calendar to ensure quoracy of meeting including chair attendance, meeting planned for February 2019. The second hour of the Joint Quality Committee will be used by the Joint Strategic Commissioning Committee re-enforcing the quality drive through our commissioning decisions.

11. OD plan development and People Plan being developed in response to staff Survey. Person Responsible: KathrynMoodyTo be implemented by: 30 Nov2018

25 Jan 2019Emma FollisThe OD Plan action in ongoing, this OD plan needs to respond to and be an enable of the system long and short term commissioning plans and be aligned to the system OD plan. these are to be developed and as such so is the CCG OD plan.

15. Quality Team to undertake assurance visits in line with planned timetable and delivery adhoc as identified.Person Responsible: KathrynMoodyTo be implemented by: 31 Mar2019

03. Internal audit identified the Commissioning Plan is not robust and not fit for purpose. The current plan requires further development to ensure this is addressed. Implementation of the plan addresses all issues, sign off by Governing Body.Person Responsible: KathrynMoodyTo be implemented by: 31 Mar2019

25 Jan 2019Emma FollisProgress against internal audit recommendations monitored via A&RiC for assurance.

I = 4 L = 28


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1.GBAF

Risk Ref

Corporate Objective






Level

Residual Score


05. CFO meetings with Regulators.Control Owner: Stuart Rees

- CFO report to the JEMT.

- Joint Finance Committee (JFC) receives reports from the CFO.

- Regulator review.

Substantial



06. Quarterly Checkpoint review with Regulators. Control Owner: Stuart Rees

- Checkpoint Process monitored via JEMT, including preparation in advance of the quarterly meetings.

- Relevant Committee oversight in response to required actions.

- Dialogue with Regulator to ensure feedback in response provided - Regulator response to exception meeting.

Substantial



07. QIPP performance reports and variations / under performance reported by exceptionControl Owner: Stuart Rees

- CFO works with Finance Team on contingencies in place.

- Reports received by the Joint Finance Committee, reported to Governing Body.

- Regulatory oversight of position.

Adequate



08. Financial performance meetings with NHSE. Medium Term financial plan submitted to NHSE in line with National guidance. Control Owner: Stuart Rees


- Assurance reporting process to JFC and GB.

- Regulatory oversight of position.

Adequate



09. CFO Triangulation meeting with Regulators. Control Owner: Stuart Rees


- Reporting process to JFC and GB.

- Regulatory oversight as required.

Substantial



10. - Contingency planning processes for potential major issues. - Surge and Capacity Plan in place and Winter Plan in place, these are tested and monitored through the Urgent and Emergency Care Transformation Programme Board (UECTPB)Control Owner: Kathryn Moody

- Relevant Executive Lead reports to JEMT.

Relevant Committee takes assurance from the business planning continuity and escalation to the GB as required.

- Annual Internal Audit plan. - National Staff Survey.

Substantial



14. Contingency of internal audit plan used to address areas of concern as they arise. Person Responsible: KathrynMoodyTo be implemented by: 31 Mar2019

25 Jan 2019Emma FollisAudit and Risk Committee in Common oversight of progress against internal audit plan. On track for delivery of internal audit plan for 18/19.

08. Final submission of the Medium Term Financial Plan will be due by 4 April 2019. Person Responsible: StuartReesTo be implemented by: 04 Apr2019

25 Jan 2019Emma FollisFinal submission of the Medium Term Financial Plan will be due by 4 April 2019.

12. OD plan development and People Plan being developed in response to staff Survey. Person Responsible: NeilBoughtonTo be implemented by: 30 Jun2019

17 Jan 2019Neil BoughtonStaff Survey action plan has been developed and approved by through the governance processes of the CCG. The 2018/19 staff survey has been undertaken and results are available toward March 2019. the CCG will then reflect upon the results and develop a new action plan to respond to the findings. The results and plan will be taken through the appropriate CCG governance arrangements. The OD Plan action in ongoing, this OD plan needs to respond to and be an enable of the system long and short term commissioning plans and be aligned to the system OD plan. these are to be developed and as such so is the CCG OD plan.


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34

1.GBAF

Risk Ref

Corporate Objective






Level

Residual Score


11. Staff Survey and reporting to the Joint Workforce Group. Control Owner: Neil Boughton

- Executive Director oversight of staff survey results.

- Reports to Joint Workforce Group. - JEMT has oversight and provides assurance to Governing Body.

- Annual Internal Audit plan - National Staff Survey.

Adequate



12. Appraisals process in place for staff. Control Owner: Stuart Rees

Direct line management responsibilities to staff.

- HR ESR reports to record progress – reported to Joint Workforce Group.

- Annual Internal Audit plan

Limited



14. Internal Audit Plan and additional contingency days.Control Owner: Stuart Rees

- JCFO agrees annual internal audit plan with internal audit.

- Internal audit plan approved by the Audit and Risk Committee in Common at the start of each financial year. Assurance reporting against progress of the plan and implementation status of internal audit recommendations reported to A&RiC, and GB as required.

- Regulatory oversight if required. - Control issues reported as part of the CCGs Annual Governance Statements.

Substantial



15. Joint Quality Team to undertake quality assurance visits as required.Control Owner: Kathryn Moody

- Executive Director oversight.

- JQC receives quality assurance visit reports.

- Northants HCP oversight. - Regulatory oversight.

Adequate



16. Deputies Group established to ensure senior oversight of key operational issues. Control Owner: Kathryn Moody

Deputies Group established to ensure senior oversight and response to key operational issues across the CCGs.

Deputies Group actions reported to the Executive Operational Group (EOG) on progress of delivery and development of integrated performance report.

Substantial




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1.GBAF

Risk Ref

Corporate Objective






Level

Residual Score


16. Directors of Strategy across providers and CCGs meet regularly.Control Owner: Caron Williams

Director of Health Strategy and Planning assurance to JEMT.

- JSCC has oversight of progress against Commissioning Plan. - Assurance sought by GB for delivery.

- Regulatory oversight for delivery. - Weekly meeting between Directors of Strategy across the system, and Joint CEO as the system planning lead. The group has been established to ensure design, delivery and system control of implementation and to ensure responsibility for the system.

Adequate


Assurance By: Emma

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